Brain metastases from renal cell carcinoma

Known patient with history of left renal malignancy with no operative intervention performed;

Left exophytic renal soft tissue mass lesion is noted at the lower pole measuring about 6.4, 6.4 and 5.4  cm in AP, SS and CC dimension. It is seen Invading the lower calyceal system with stranding of the surrounding and abutting the left psoas muscle with no line of cleavage.

This is associated with a rather well defined cortical focal soft tissue lesion at the upper left kidney measuring about 10 x 10 mm. anther Two a rather well defined cortical focal soft tissue lesion at the upper and lower zone of the right kidney measuring about 14 x 14 mm and 12 x 12 mm respectively.

Bulky left supra renalsuprarenal gland with heterogeneously enhancing soft tissue lesion of the right supra renalsuprarenal gland measuring 21 x 13 mm  withwith attenuation density more than 15 HU in the non contrast-contrast study.

Multiple metastatic lesions noted involving both cerebral hemispheres, notably the left frontal and right temporal lobes  & at the left cerebellar hemisphere. They show enhancing soft tissue and degenerated & cystic components. The largest lesion is noted at the right temporal lobe measuring about 3 x 2.7 x 3 cm in size. Mild peri-lesional edema noted. No mid-line shift detected.

Cerebral metastasisis common and is suspected in patients with primary malignancies with neurological manifestations. RenalRenal cell carcinoma is one of the commonest primaries of brain metastasis.

Cerebral metastasismetastases are usually solid, however, it can show cystic changes as a tumor associated-associated cysts or due to necrosis, also it can be predominately cystic with a marginal enhancing solid component. Brain metastasis can show hemorrhagic changes, especially at their cystic component. Other common primaries include; lung cancer, breast cancer, Colo-rectal carcinoma and melanoma.

HalfAbout half of brain metastasis are solitary, and history of primary malignancy aids in suggesting metastasis rather than primary tumor, especially if associated with other sites of metastasis. As solitary metastasis can entirely appear in MRI like primary intra-cranial tumor .... as it reflects different management and prognosis.

MRI is more sensitive than CT in detecting brain metastasis, especially in contrast-enhanced T1 WI.